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- Falkenberg, Laura J., et al.
(författare)
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Climate change and the ocean
- 2023
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Ingår i: Oceans and Human Health: Opportunities and Impacts. - 9780323952279 ; , s. 265-288
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- The Earth's atmosphere is increasingly modified by human activities that are driving directional, sustained, and rapid global change. There will be a cascade of impacts on marine systems including sea level rise, storm events, ocean acidification, changes in salinity (primarily ocean freshening), and ocean warming and marine heatwaves. These global-scale changes will combine to impact human physical and mental health via changes to, for example, coastal ecosystems, infrastructure, and resources (e.g., freshwater supplies, food security and safety, medical compounds); disease transmission via mosquito-borne diseases, naturalized organisms, fecal-oral pathways; extreme conditions such as rainfall, storm surges, and flooding; pollutants, including in the air; and human displacement and migration. The impact of these global changes will depend on the local climate, nonclimate environmental conditions, and socioeconomic contexts in which they manifest. Understanding these complexities is central to managing our ocean so that we ensure human health under a future climate.
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| 2. |
- Manzano-Nunez, Ramiro, et al.
(författare)
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Outcomes and management approaches of resuscitative endovascular balloon occlusion of the aorta based on the income of countries
- 2020
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Ingår i: World Journal of Emergency Surgery. - : Springer Science and Business Media LLC. - 1749-7922. ; 15:57
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Tidskriftsartikel (refereegranskat)abstract
- © 2020 The Author(s). Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) could provide a survival benefit to severely injured patients as it may improve their initial ability to survive the hemorrhagic shock. Although the evidence supporting the use of REBOA is not conclusive, its use has expanded worldwide. We aim to compare the management approaches and clinical outcomes of trauma patients treated with REBOA according to the countries' income based on the World Bank Country and Lending Groups. Methods: We used data from the AORTA (USA) and the ABOTrauma (multinational) registries. Patients were stratified into two groups: (1) high-income countries (HICs) and (2) low-to-middle income countries (LMICs). Propensity score matching extracted 1:1 matched pairs of subjects who were from an LMIC or a HIC based on age, gender, the presence of pupillary response on admission, impeding hypotension (SBP ≤ 80), trauma mechanism, ISS, the necessity of CPR on arrival, the location of REBOA insertion (emergency room or operating room) and the amount of PRBCs transfused in the first 24 h. Logistic regression (LR) was used to examine the association of LMICs and mortality. Results: A total of 817 trauma patients from 14 countries were included. Blind percutaneous approach and surgical cutdown were the preferred means of femoral cannulation in HICs and LIMCs, respectively. Patients from LMICs had a significantly higher occurrence of MODS and respiratory failure. LR showed no differences in mortality for LMICs when compared to HICs; neither in the non-matched cohort (OR = 0.63; 95% CI: 0.36-1.09; p = 0.1) nor in the matched cohort (OR = 1.45; 95% CI: 0.63-3,33; p = 0.3). Conclusion: There is considerable variation in the management practices of REBOA and the outcomes associated with this intervention between HICs and LMICs. Although we found significant differences in multiorgan and respiratory failure rates, there were no differences in the risk-adjusted odds of mortality between the groups analyzed. Trauma surgeons practicing REBOA around the world should joint efforts to standardize the practice of this endovascular technology worldwide.
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